Syncope is a common cause of medical visit or hospitalization. Its prognosis is largely unpredictable, depending on the origin of the sudden loss of consciousness. Reporting a much higher mortality rate than its non-cardiac counterpart, cardiac syncope finds its major causes in hypokalemia, cardiac arrhythmia, ischemia/infarction, heart failure or structural cardiac disease. A 38-year-old man presented with recurrent syncope visited our family medicine out-patient clinic. He had a history of asymptomatic congenital heart disease and no current medication. There was no significant family history. With physical examination, high blood pressure (right arm 149/90 mmHg) at sitting position and tachycardia (pulse rate 112/min) and systolic heart murmur (grade 2-3) were noted. The 12-lead ECG revealed prolonged QT (QTc=522 msec). Laboratory investigation showed severe hypokalemia (K+ 2.5 mmol/L), elevated liver enzymes (aspartate aminotransferase 145 IU/L, alanine aminotransferase 47 IU/L, gamma glutamyl transferase 959 IU/L), anemia (hemoglobin 11.7g/dL) and thrombocytopenia (platelet count 62000/μL). The patient had smoked, chewed betel nuts, and drunk wine since late adolescence. Current alcohol consumption was 3-4 cans of beer daily. He was transferred to cardiologist and admitted to the cardiac ward due to suspected diagnosis of ventricular tachycardia. Bloody stool was noted and hemoglobin dropped to 8.9 g/L on Day 4 of hospitalization, and serum K+ corrected to 3.0 mmol/L by Day 6. He was discharged with oral prescription 2 days after. The patient returned to the cardiology clinic for follow-up one week later, when laboratory test revealed serum K+ 3.2 mmol/L and hemoglobin 11.5 g/dL. He was found dead in the morning 10 days after. We reported and discussed the findings of this patient’s investigation with a focus on studying the adverse health effects of heavy alcohol use.
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